冠状动脉旁路移植术与二尖瓣手术后自主神经功能变化及对心房颤动预测的对比研究

Comparative analysis of autonomic nervous function alterations and atrial fibrillation prediction following coronary artery bypass grafting and mitral valve surgery

目的比较冠状动脉旁路移植术(CABG)和二尖瓣手术(MVS)患者术后自主神经功能的变化特征,探讨心率变异性(HRV)指标在术后心房颤动(POAF)中的预测价值。方法选取2020年4月至2022年4月北部战区总医院心血管外科收治的548例接受CABG或MVS发生POAF的患者,男性380例,女性168例,年龄(64.47±7.41)岁,年龄范围为32~80岁。根据手术类型将患者分为CABG组(n=431)与MVS组(n=117)。术前7 d至术后7 d连续进行Holter监测,记录并分析HRV指标,包括低频(LF)、高频(HF)、低频/低频比值(LF/HF)、N-N间期标准差(SDNN)、短期心率变异性连续差值的均方根(rMSSD)和反映心跳间隔波动的连续RR间期差异超过50 ms的百分比(pNN50)。结果CABG组较MVS组在多个HRV指标上表现出显著差异,包括HF(P=0.013)、rMSSD(P=0.007)和pNN50(P=0.006)。CABG组HRV指标随时间呈现显著动态变化,特别是在房颤发生前30 min,LF和HF显著升高。MVS组HRV指标波动较小,术后恢复较为平稳。结论CABG术后患者的自主神经功能波动较大,尤其在POAF发生前存在特征性变化,提示HRV监测可作为POAF预测的有效工具。MV的自主神经功能相对稳定,术后监测策略可相应简化。

Objective To compare the changes in autonomic nervous function post-surgery between patients undergoing coronary artery bypass grafting(CABG)and mitral valve surgery(MVS),and to explore the predictive value of heart rate variability(HRV)indicators in postoperative atrial fibrillation(POAF).Methods A total of 548 patients who underwent CABG or mitral valve surgery and developed POAF in the cardiovascular surgery department of Northern Theater General Hospital from April 2020 to April 2022 were selected,including 380 males and 168 females,with an average age of(64.47±7.41)years,ranging from 32 to 80 years.Patients were divided into CABG group(n=431)and MVS group(n=117)based on the type of surgery.Holter monitoring was conducted continuously from 7 days before to 7 days after surgery to record and analyze HRV indicators,including low frequency(LF),high frequency(HF),low frequency/high frequency(LF/HF)ratio,standard deviation(SDNN),short-term heart rate variability(rMSSD),and pNN50.Results The CABG group showed significant differences in multiple HRV indicators compared to the MVS group,including HF(P=0.013),rMSSD(P=0.007),and pNN50(P=0.006).The HRV indicators in the CABG group exhibited significant dynamic changes over time,particularly a notable increase in LF and HF in the 30 minutes preceding the onset of atrial fibrillation.The HRV indicators in the MVS group fluctuated less,indicating a relatively stable recovery post-surgery.Conclusion The autonomic nervous function of patients post-CABG exhibits considerable fluctuations,particularly with characteristic changes prior to the occurrence of POAF,suggesting that HRV monitoring could serve as an effective tool for predicting POAF.The autonomic nervous function of patients undergoing mitral valve surgery is relatively stable,allowing for a corresponding simplification of postoperative monitoring strategies.